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Repetitive strain injury

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Repetitive strain injury

Repetitive strain injuries (RSIs) are "injuries of the musculoskeletal and nervous systems that may be caused by repetitive tasks, forceful exertions, vibrations, mechanical compression (pressing against hard surfaces), or sustained or awkward positions".[1]. RSI is also known as cumulative trauma disorders, repetitive stress injuries, repetitive motion injuries or disorders, musculoskeletal disorders, and [occupational] overuse syndromes.

Definition

Repetitive strain injury (RSI) is a syndrome incorporating several discrete conditions associated with activity-related arm pain such as edema, tendinitis, carpal tunnel syndrome, cubital tunnel syndrome, thoracic outlet syndrome, DeQuervain's syndrome, stenosing tenosynovitis, intersection syndrome, golfer's elbow or medial epicondylitis, tennis elbow or lateral epicondylitis, reflex sympathetic dystrophy syndrome (RSDS), thoracic outlet syndrome, radial tunnel syndrome, and focal dystonia.

RSI is also used as an umbrella term for non-specific illnesses popularly referred to as Blackberry thumb, iPod finger, gamer's thumb (a slight swelling of the thumb caused by excessive use of a gamepad), Rubik's wrist or "cuber's thumb" (tendinitis, carpal tunnel syndrome, or other ailments associated with repetitive use of a Rubik's Cube for speedcubing), Trigger finger, Stylus Finger" (swelling of the hand caused by repetitive use of mobile devices and mobile device testing.), Raver's Wrist, caused by repeated rotation of the hands for many hours (for example while holding glow sticks during a rave), and others.

Doctors have recently begun making a distinction between tendinitis and tendinosis in RSI injuries. There are significant differences in treatment between the two, for instance in the use of anti-inflammatory medicines, but they often present similar symptoms at first glance and so can easily be confused.

The following complaints are typical in patients who might receive a diagnosis of RSI:[2]

  • Short bursts of excruciating pain in the arm, back, shoulders, wrists, hands, or thumbs (typically diffuse – i.e. spread over many areas).
  • The pain is worse with activity.
  • Weakness, lack of endurance.

Causes

Gloves to avoid RSI during typing.

RSI is believed by many to be caused due to lifestyle without ergonomic care [citation needed], E.g. While working in front of computers, driving, traveling etc. Simple reasons like 'Using a blunt knife for everyday chopping of vegetables', may cause RSI.

Other typical habits that some sources believe lead to RSI:[citation needed]

  • Reading or doing tasks for extended periods of time while looking down.
  • Sleeping on an inadequate bed/mattress or sitting in a bad armchair and/or in an uncomfortable position.
  • Carrying heavy items.
  • Holding one's phone between neck and shoulder.
  • Watching TV in incorrect position e.g. Too much to the left/right.
  • Sleeping with head forward, while traveling.
  • Prolonged use of the hands, wrists, back, neck, etc.
  • Sitting in the same position for a long period of time.

Treatment

RSIs are assessed using a number of objective clinical measures. These include effort-based tests such as grip and pinch strength, diagnostic tests such as Finkelstein's test for Dequervain's tendinitis, Phalen's Contortion, Tinel's Percussion for carpal tunnel syndrome, and nerve conduction velocity tests that show nerve compression in the wrist. Various imaging techniques can also be used to show nerve compression such as x-ray for the wrist, and MRI for the thoracic outlet and cervico-brachial areas.

The most-often prescribed treatments for early-stage RSIs include drug therapies such as anti-inflammatory medications combined with passive forms of physical therapy such as rest, splinting, massage and the like. Low-grade RSIs can sometimes resolve themselves if treatments begin shortly after the onset of symptoms. However, some RSIs may require more aggressive intervention including surgery and can persist for years.

General exercise has been shown to decrease the risk of developing RSI.[3]. Doctors sometimes recommend that RSI sufferers engage in specific strengthening exercises, for example to improve sitting posture, reduce excessive kyphosis, and potentially thoracic outlet syndrome.[4]


Since workstation design often contributes to RSIs, ergonomic adjustments of the workstations are often recommended.

Adjunct Intervention

Ergonomics

Modifications of posture and arm use (ergonomics) are often recommended.[5] Specially designed tools such as pliers are now widely available for production line workers to minimise the risks of repetitive strain injuries. The handles of such pliers are bent so that the workpiece is aligned with the arm, wrist and hand. The handles are also designed to maximise grip using both thermoplastics and rubber.

Ergonomics: the science of designing the job, equipment, and workplace

Adaptive software

Main article: List of repetitive strain injury software

There are several kinds of software designed to help in repetitive strain injury. Among them, there are speech recognition software, and break timers. Break timers software reminds the user to pause frequently and perform exercises while working behind a computer. There is also automated mouse-clicking software that has been developed, which can automate repetitive tasks in games and applications.

Adaptive hardware

Adaptive technology ranging from special keyboards, mouse replacements to pen tablet interfaces might help improve comfort.

Mouse

Switching to a much more ergonomic mouse, such as a roller mouse, vertical mouse or joystick, or switching from using a mouse to a stylus pen with graphic tablet may provide relief, but in chronic RSI they may result only in moving the problem to another area. Using a graphic tablet for general pointing, clicking, and dragging (i.e. not drawing) may take some time to get used to as well. Switching to a trackpad or pointing stick, which requires no gripping or tensing of the muscles in the arms may help as well. Inertial mice (which do not require a surface to operate) might offer an alternative where the user's arm is in a less stressful thumbs up position rather than rotated to thumb inward when holding a normal mouse. Also, since they do not need a surface to operate ("air mice" function by small, forceless, wrist rotations), the wrist and arm can be supported by the desktop.

Ergonomic accessories for the mouse can also make a difference. An accessory developed recently includes finger pads to create a softer surface for clicking as well as for helping the joints bend more when clicking. Additionally the accessory developed by the gel pads on mouse manufacturer includes a palm pad on the mouse to help the hand achieve a more grasping position further increasing overall ergonomics.

Keyboards and keyboard alternatives

Exotic keyboards by manufacturers such as Datahand, OrbiTouch, Maltron and Kinesis are available. Also one can use digital pens to avoid the strain coming from typing itself[dubious – discuss]. Other solutions move the mode of input from one's hands entirely. These include the use of voice recognition software or pedals designed for ergonomics and gaming to supplant normal keyboard input.

DataHand Professional II Keyboard, right side

See also

Footnotes

  1. ^ Public Employees Occupational Safety and Health Program of the New Jersey Department of Health and Senior Services
  2. ^ Ring D, Kadzielski J, Malhotra L, Lee SG, Jupiter JB (2005). "Psychological factors associated with idiopathic arm pain". J Bone Joint Surg Am. 87 (2): 374–80. doi:10.2106/JBJS.D.01907. PMID 15687162. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  3. ^ Ratzlaff, C. R. (2007). "Work-Related Repetitive Strain Injury and Leisure-Time Physical Activity". Arthritis & Rheumatism (Arthritis Care & Research). 57 (3): 495–500. doi:10.1002/art.22610. PMID 17394178. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
  4. ^ Carolyn Kisner & Lyn Allen Colby, Therapeutic Exercise: Foundations and Techniques, at 473 (5th Ed. 2007).
  5. ^ Berkeley Lab. Integrated Safety Management: Ergonomics. Website. Retrieved 9 July 2008.

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